Clinical Research Coverage Analyst

About the role

The Clinical Research Coverage Analyst supports the School of Medicine’s clinical research community by ensuring that research studies are billed correctly and comply with Medicare, third‑party payer, and sponsor requirements. The role involves reviewing trial protocols, performing coverage analyses, and providing education to investigators and coordinators.

Key responsibilities

• Review clinical trial protocols to determine Qualified Clinical Trial (QTC) status in accordance with CMS policy.
• Create detailed Coverage Analyses that identify which services are routine care and billable to patient insurance versus sponsor‑funded.
• Serve as subject‑matter expert on National and Local Coverage Determinations (NCD/LCD) and resolve protocol‑related billing discrepancies.
• Liaise with the partnering hospital to build study orders in the EMR, submit build forms, and maintain build tracking spreadsheets.
• Develop and deliver training sessions, tools, and standardized policies for the university’s clinical research staff.
• Assist with the overall management of the clinical trials organization and attend related meetings.

Required profile

• Strong knowledge of regulations and guidelines governing clinical research and Medicare/medical billing.
• Excellent analytical, organizational, and decision‑making abilities.
• Detail‑oriented with the capacity to independently research complex source materials.
• Effective verbal and written communication skills, including experience presenting to groups.

Required skills

• Understanding of CMS policies, NCDs, and LCDs.
• Familiarity with clinical trial documentation and EMR systems.
• Knowledge of Medicare and third‑party billing processes.